Kebede,
D., Alem, A. (1999) Major mental disorders in Addis Ababa, Ethiopia.
II. Affective disorders. Acta Psychiatr Scand Suppl 1999;397:18-23 -
ABSTRACT This report examines the prevalence
and socio-demographic correlates of affective disorders
based on a survey conducted in Addis Ababa between
September and December of 1994. An Amharic version
of the CIDI was used to collect data from a random
community sample of 1420 individuals aged 15 and above.
The lifetime prevalence for specific affective disorders
was as follows: bipolar disorders 0.3%, depressive
episodes 2.7%, recurrent depressive episodes 0.2%,
and persistent mood disorders 1.6%. The weighted lifetime
prevalence of affective disorders was 5.0% (women
7.7% and men 3.2%). One-month prevalence was 3.8%
(women 5.9% and men 2.3%). After adjusting for several
potential confounders, the risk of affective disorders
was only 29% higher in women compared to men. This
difference in risk was not statistically significant.
Age was also not associated with risk of affective
disorders. On the other hand, education was associated
with the risk of disorder, the risk decreasing with
increasing educational attainment. This inverse trend
was statistically significant (P for trend = 0.02).
The risk was also 37% lower in the employed than the
unemployed: Odds Ratio (OR), 95% confidence interval
(95% CI) = 0.63 (0.39, 1.01). There were no statistically
significant associations between affective disorders
and marital status or ethnicity
Kebede,
D., Alem, A. (1999) Major mental disorders in Addis Ababa, Ethiopia.
III. Neurotic and somatoform disorders Acta Psychiatrica Scandinavica, Supplementum, 100,
24-29.
ABSTRACT Estimated the prevalence and sociodemographic
correlates of phobic, dissociative, somatoform, and
other anxiety disorders. Estimates of lifetime and
point (1-mo) prevalence are based on a survey conducted
in Addis Ababa in 1994, using an Amharic version of
the Composite International Diagnostic Interview to
collect data from 1,420 city residents aged 15 yrs
and above. Sociodemographic correlates were sex, age,
education, employment and marital status, and ethnicity.
Phobic anxiety disorders were the most common of the
anxiety disorders, with lifetime prevalence (LP) of
4.8%. LP for dissociative disorders was .8%; for other
anxiety disorders 2.7%, and for somatoform disorders
3.1%. LP for all neurotic and somatoform disorders
was 10.8%. Point prevalence estimates (percent) were:
phobic anxiety disorders 4.4; other anxiety disorders
1.2; dissociative disorders .4; and somatoform disorders
2.5. Women had over a 2-fold risk of neurotic and
somatoform disorders compared to men. Those aged 60
yrs and above had a 60% lower risk compared to those
aged 15-24 yrs. The 25% decreased risk for the employed
vs unemployed, was not statistically significant.
Education, marital status, and ethnicity were not
significantly associated with neurotic and somatoform
disorders.
Kellner
M, Wiedemann K, Yassouridis A, Levengood R, Guo LS,
Holsboer F, Yehuda R (2000) Max Planck Institute of Psychiatry,
Clinical Institute, Munich, Germany. Behavioral and endocrine response to cholecystokinin
tetrapeptide in patients with posttraumatic stress disorder.
Biol Psychiatry 2000 Jan 15;47(2):107-11
ABSTRACT BACKGROUND: Given the relationship
between posttraumatic stress disorder (PTSD) and panic,
it was of interest to examine whether panic provoking
agents affect PTSD symptoms. We therefore investigated
the behavioral and endocrine response of PTSD patients
to the panicogen cholecystokinin tetrapeptide (CCK-4).
METHODS: Eight patients with PTSD (DSM-IV) received
50 micrograms CCK-4 intravenously in a placebo-controlled,
double-blind balanced design. Provocation of panic,
anxiety, and flashbacks was assessed. Plasma adrenocorticotropin
(ACTH) and cortisol levels after CCK-4 were measured
and compared to healthy subjects matched for age,
gender, and provoked symptoms. RESULTS: Despite significant
effects of CCK-4 on anxiety and panic symptoms, no
significant provocation of flashbacks emerged. CCK-4-induced
panic symptoms showed an inverse correlation to trait
dissociation. The ACTH response after CCK-4 was significantly
lower in PTSD patients than in controls. Cortisol
was similarly increased in both groups after CCK-4,
but PTSD patients showed a more rapid decrease of
stimulated cortisol concentrations. CONCLUSIONS: Panic
symptoms or heightened anxiety are not necessarily
conditioned stimuli for the provocation of posttraumatic
flashbacks. Further studies in PTSD with different
panicogens should be controlled for the potential
interference of trait dissociation. Our hormone data
show further evidence for a corticotropin-releasing
hormone (CRH) overdrive and enhanced negative glucocorticoid
feedback in PTSD patients
Kessler,
B.L ; Bieschke (1999) A retrospective analysis of shame, dissociation,
and adult victimization in survivors of childhood sexual
abuse. Journal of Counseling Psychology, 46(3), 335-341.
King, Brenda Jayne(2002) Dissociation: An examination of memory processes. Dissertation Abstracts International: Section B:
the Sciences & Engineering. Vol 62(8-B), Mar 2002, 3823
ABSTRACT A directed forgetting task, using the fist-cuing method, was used to
investigate whether dissociators differ in memory performance from non
dissociators when material is subject to an intention to forget. Three
conditions were used to determine whether context affects memory
performance: no load, neutral load, and evocative load. Dissociators showed
poorer recall than nondissociators in the no load and neutral conditions
while performance on a recognition task was equivalent. This indicates that
dissociators can more successfully inhibit retrieval of material subject to
an intention to forget under some circumstances. When presented with the
evocative condition, dissociators did not maintain greater forgetting. It
is hypothesized that the evocative condition makes associative cues more
salient so that to-be-forgotten material is more readily accessed and
inhibition of retrieval is less likely to occur. Subjects were also
presented with a proactive interference task as another means of sampling
inhibition of retrieval. No differences existed between groups on this task.
Michael
King, PhD; Adrian Coxell, DClinPsy ; Gillian Mezey,
FRCPsych (2001) Department of Psychiatry and Behavioural
Sciences, Royal Free and University College Medical
School, Royal Free Campus, Rowland Hill Street, London
NW3 2PF, UK. E-mail: m.king@rfc.ucl.ac.uk Sexual molestation of males: associations with psychological
disturbance The British Journal of Psychiatry (2002) 181: 153-157
ABSTRACT OBJECTIVE: Background There are
no epidemiological data in Europe on associations
between sexual molestation in males and psychological
disturbance. Aims To investigate whether sexual molestation
in males is a significant predictor of psychological
disturbance. Method We recruited men attending general
practice and genitourinary medicine services. Participants
took part in a computerised interview about sexual
molestation as children or adults. We ranked reported
sexual experiences into three categories of decreasing
severity. Each category was treated as an independent
predictor in a multivariate analysis predicting different
types of psychological disturbance. Results Men who
reported child sexual abuse were more likely to report
any type of psychological disturbance. Men who reported
sexual molestation in adulthood were 1.7 (1.0-2.8)
times more likely to have experienced a psychological
disorder, but self-harm was the single most likely
problem to occur (odds ratio=2.6, range=1.3-5.2).
Men reporting ‘consenting’ sexual experiences when
aged under 16 years also were more likely to report
acts of self-harm (odds ratio=1.7, range=0-2.8). Conclusions
Sexual abuse as a child or adult is associated with
later psychological problems. All forms of sexual
molestation were predictive of deliberate self-harming
behaviour in men.
Kisiel
CL, Lyons JS.(2001)
Dissociation as a mediator of psychopathology among
sexually abused children and adolescents. Am J Psychiatry 2001 Jul;158(7):1034-9
ABSTRACT OBJECTIVE: This study investigated
the role of dissociation as a mediator of mental health
outcomes in children with a history of sexual abuse.
METHOD: The study group consisted of 114 children
and adolescents (ages 10-18 years) who were wards
of the Illinois Department of Children and Family
Services and were living in residential treatment
centers. Interviews, provider ratings, and chart reviews
were used to assess the relationship of childhood
abuse history, dissociative responses, and psychopathology.
RESULTS: Sexual abuse history was significantly associated
with dissociation, whereas a history of physical abuse
was not. Both sexual abuse and dissociation were independently
associated with several indicators of mental health
disturbance, including risk-taking behavior (suicidality,
self-mutilation, and sexual aggression). Severity
of sexual abuse was not associated with dissociation
or psychopathology. Analysis of covariance indicated
that dissociation had an important mediating role
between sexual abuse and psychiatric disturbance.
These results were replicated across several assessment
sources and varied perspectives. CONCLUSIONS: The
findings suggest a unique relationship between sexual
abuse and dissociation. Dissociation may be a critical
mediator of psychiatric symptoms and risk-taking behavior
among sexually abused children. The assessment of
dissociation among children may be an important aspect
of treatment.
Klain,
E. and L. Pavi . (1999) Countertransference and empathic problems in therapists/helpers
working with psychotraumatized persons Croatian Medical Journal = ISSN 0353-9504: Vol.
40 (1999), no. 4
ABSTRACT Countertransference in therapists
working with patients with posttraumatic stress disorder
(PTSD) differs from countertransference in other psychotherapeutical
settings. In this article we discuss the specificities
of counter- transference in treating PTSD patients
and its relation to empathy. The most difficult countertransference
problems occur in treating multiply traumatized patients.
Countertransference may occur towards an event (e.g.,
war), patients who have killed people, as well as
to colleagues who avoid treating PTSD patients, or
towards a supervisor who avoids, either directly or
indirectly, supervision of therapists working with
PTSD patients. Our recommendation for the prevention
of problems in treating PTSD patients include : 1)
careful selection of the therapist or helper, both
in the personality structure and training; 2) prevention
by debriefing and team work and peer supervision;
and 3) education - theoretical, practical, and therapeutical
Kluft
R.P. (1999) An overview of the psychotherapy of dissociative
identity disorder. Am J Psychother 1999 Summer;53(3):289-319
ABSTRACT Dissociative Identity Disorder (DID)
is identified and studied with increasing frequency.
However, the controversy that often surrounds DID
can make it difficult to approach its treatment in
a circumspect manner. This paper will provide an overview
of DID treatment as it is practiced by those experienced
and skilled in the treatment of this group of patients.
The treatment of DID resembles the treatment of other
traumatized populations in that it is stage-oriented,
beginning with supportive and strengthening work.
Various stances toward the treatment of DID are reviewed,
and specific issues that arise in the psychotherapy
of DID are addressed, such as pragmatic arrangements,
informed consent, work with alters, and the use of
specific techniques, such as hypnosis. The employment
of therapeutic modalities and ancillary therapies
is discussed. The heterogeneity of DID patients is
reviewed, and the characteristics of three general
groups of DID patients, high, intermediate, and low
in both function and prognosis, are explored. Considerations
in the matching of DID patients to either exploratory
or supportive treatments are discussed, and observations
are made about both trauma work and the supportive
psychotherapy of DID.
Kluft
R.P.; Foote B (1999) Dissociative identity disorder: recent developments.
Am J Psychother 1999 Summer;53(3):283-8
Kluft
R.P.(1999) Current issues in dissociative identity disorder
Journal of Practical Psychiatry and Behaviral Health,
5, 3-19.
van
der Kolk, Bessel A (2002) Boston University School of Medicine,
Boston MA, USA; Trauma Center, Boston MA, USA. Psychoanalytic Dialogues (ISSN: 1048-1885), v. 12,
no. 3, pp. 381-392 (2002). Posttraumatic therapy in the age of neuroscience.
ABSTRACT When people develop PTSD in the
wake of exposure to a traumatic event, the imprint
of that trauma comes to dominate how they organize
their way in the world. Verbalizing, making meaning,
and putting the event in context may provide a means
of feeling understood, rejoining the human race, and
gaining perspective on the experience, but it may
do little to reorganize the person to feel safe and
focused on fulfilling the demands of the present.
Given the subcortical nature of trauma imprints, effective
therapy needs to help survivors tolerate the sensory
reminders of the trauma, and physically experience
efficacy and purpose in response to stimuli that once
triggered feelings of helplessness and dependence.
van
der Kolk, Bessel A; Hopper, James W; Osterman, Janet
E. (2001) Exploring the nature of traumatic memory: combining
clinical knowledge with laboratory methods. Journal of Aggression, Maltreatment and Trauma (ISSN:
1092-6771), v.4, no 2, pp. 9-31(2001).
ABSTRACT For over 100 years clinicians have
observed and described the unusual nature of traumatic
memories. It has been repeatedly and consistently
observed that these memories are characterized by
fragmentary and intense sensations and affects, often
with little or no verbal narrative content. Yet, possibly
because traumatic memories cannot be precipitated
under laboratory conditions, the organization of traumatic
memories has received little systematic scientific
investigation. In our laboratory we have developed
an instrument, the Traumatic Memory Inventory (TMI),
which systematically assesses the ways that memories
of traumatic experience are organized and retrieved
over time. In this article we report findings from
our third study using the TMI, of 16 subjects who
had the traumatic experience of awakening from general
anesthesia during surgery. We assessed changes in
traumatic memory characteristics over time and differences
between memories of subjects with and without current
PTSD. Our findings suggest the need for more rigorous
methods for the assessment of the evolution of traumatic
memories. In order to develop a comprehensive and
integrated understanding of the nature of traumatic
memory, we need to combine careful clinical observations
with replicable laboratory methods, including those
of cognitive science and neuroscience. KEY WORDS:
memory, awareness during anesthesia, PTSD, traumatic
memories
van
der Kolk, Bessel A. (2001) The psychobiology and psychopharmacology of PTSD. Human Psychopharmacology (ISSN: 0885-6222), v. 16,
no. Supplement 1, pp. S49-S64 (January 2001).
ABSTRACT This paper reviews the currently
available knowledge about the psychobiology and psychopharmacology
of PTSD. It also reviews the various studies that
have elucidated changes in brain function and structure
in PTSD populations, including position emission tomography
(PET), single photon emission computed tomography
(SPECT), and event-related potential (ERP) studies.
It then reviews the literature on catecholamine and
hypothalamic-pituitary-adrenal (HPA) axis abnormalities
in PTSD, and finally reviews the literature available
on the psychopharmacology of PTSD. It discusses how
the pathophysiology of PTSD determines the nature
of psychopharmacological interventions. Psychopharmacological
interventions in PTSD are largely limited to good
studies on the effects of the selective serotonin
reuptake inhibitors (SSRIs). In order to effectively
intervene in PTSD, studies of other psychopharmacological
agents are necessary, specifically of agents which
affect limbic activation, decreased frontal lobe functioning,
altered HPA activity, and other biological features
of PTSD. [Author Abstract] KEY WORDS: PTSD; psychopharmacology;
SSRIs; psychobiology; brain lateralization; amygdala;
hippocampus
van
der Kolk, Bessel A.; Streeck-Fischer, Annette .
(2000) Down will come baby, cradle and all: diagnostic and
therapeutic implications of chronic trauma on child
development Australian and New Zealand Journal of Psychiatry
(ISSN: 0004-8674), v. 34, no. 6, pp. 903-918 (December
2000).
ABSTRACT OBJECTIVE: This review examines
the clinical outcomes associated with exposure to
chronic intrafamilial trauma and explores the treatment
of the psychological, biological, and cognitive sequelae.
METHOD: The existing research literature on the subject
was collected, using Index Medicus/MEDLINE, Psychological
Abstracts, and the PILOTS database. The research findings
were supplemented with clinical observations by the
authors and other clinical writings on this topic.
RESULTS: Children with histories of exposure to multiple
traumatic experiences within their families or in
medical settings usually meet criteria for numerous
clinical diagnoses, none of which capture the complexity
of their biological, emotional, and cognitive problems.
These are expressed in a multitude of psychological,
cognitive, somatic, and behavioural problems, ranging
from learning disabilities to aggression against self
and others. CONCLUSIONS: Exposure to intrafamilial
violence and other chronic trauma results in pervasive
psychological and biological deficits. Treatment needs
to address issues of safety, stabilise impulsive aggression
against self and others, promote mastery experiences,
compensate for specific developmental deficits, and
judiciously process both the traumatic memories and
trauma-related expectations.
van
der Kolk, Bessel A.(2000) Trauma, neuroscience, and the etiology of hysteria:
an exploration of the relevance of Breuer and Freud's
1893 article in light of modern science Journal of the American Academy of Psychoanalysis
(ISSN: 0090-3604), v. 28, no. 2, pp. 237-262 (Summer
2000).
ABSTRACT OBJECTIVE: The discovery of trauma
as an etiological factor in mental disorders is more
than a century old, but trauma has only been part
of our contemporary lexicon for the past 20 years.
Like a century ago, when there was an explosion in
the careful description of psychological processes,
the past two decades have seen a sudden increase of
knowledge about how experience shapes the central
nervous system and the formation of the self. Developments
in the neurosciences are starting to make significant
contributions to our understanding of how the brain
is organized by experience, what areas are most malleable,
and which are most resistant to change. These studies
are beginning to clarify how life itself continues
to transform the ways biology is expressed. Like a
century ago, the study of trauma has been an extremely
fertile area for developing a deeper understanding
of the interrelationship among emotional, cognitive,
social, and biological forces that shape human development.
Starting with PTSD in adults, but expanding into early
attachment and coping with overwhelming experiences
in childhood, our field has discovered how certain
experiences can "set" psychological expectations
and biological selectivity. Research in these areas
has opened up entirely new insights in how extreme
experiences throughout the life cycle can have profound
effects on memory, affect regulation, biological stress
modulation, and interpersonal relatedness. These findings,
in the context of the development of a range of new
therapy approaches, are beginning to open up new perspectives
on how traumatized individuals can be helped to overcome
their past. Some of these methods are likely to jell
with the brilliant observations of Breuer and Freud
in 1893, while others, like the discoveries of a century
ago, may again radically depart from preexisting explanatory
frameworks.
van der Kolk, Bessel
A.; Gersons, Berthold P R; Carlier, Ingrid V E; Lamberts,
Regina D; (2000). Department
of Psychiatry, University of Amsterdam, Amsterdam, The
Netherlands; Harvard Medical School, Boston MA, USA. Randomized clinical trial of brief eclectic psychotherapy
for police officers with posttraumatic stress disorder Journal of Traumatic Stress (ISSN: 0894-9867), v.
13, no. 2, pp. 333-347 (April 2000).
ABSTRACT The authors report on a randomized,
controlled clinical trial on the treatment of PTSD,
comparing manualized psychotherapy to wait-list control.
This is the first study to evaluate Brief Eclectic
Psychotherapy (BEP), which combines cognitive-behavioral
and psychodynamic approaches within one treatment
method. 42 police officers with the diagnosis of PTSD
participated in the study; 22 were randomly assigned
to the treatment group and 20 to the wait-list control
group. Assessments of PTSD and comorbid conditions
were made 1 week before treatment, after treatment
session 4, upon termination of treatment (16 sessions),
and at follow-up 3 months later. As expected, no significant
differences between groups were observed at pretest
or at session 4. At posttest and at follow-up, BEP
had produced significant improvement in PTSD, in work
resumption, and in some comorbid conditions.
Van der Kolk, Bessel
A; Pelcovitz, David(1999). Department
of Psychiatry, Harvard Medical School, Boston MA, USA;
Department of Psychology, New York University School of
Medicine, New York NY, USA. Clinical applications
of the Structured Interview for Disorders of Extreme Stress
(SIDES). National Center for PTSD Clinical
Quarterly (ISSN: 1052-7168), v. 8, no. 2, pp. 21, 23-26
(Spring 1999).
ABSTRACT The SIDES provides clinicians and
researchers with a rational way of measuring the associated
features of PTSD. The measure allows for further studies
to provide empirical support for expanding the current
PTSD DSM-IV diagnosis to include an additional category
of "Disorders of Extreme Stress." It can also guide
clinicians to set priorities in the care of traumatized
patients. From a research point of view, it provides
a vehicle for the systematic study of post-traumatic
changes across different trauma populations. [Text,
p. 24]
van der Kolk BA(1998)
Boston University Medical School, Brookline, MA 02146,
USA. Psychology and psychobiology of childhood
trauma Prax Kinderpsychol Kinderpsychiatr 1998 Jan;47(1):19-35
[ Article in German]
Cornelis G. Kooiman
;
Sonja van Rees Vellinga, Philip Spinhoven, Nel Draijer,
Rutger W. Trijsburg, Harry G.M. Rooijmans (2004) aDepartment of Psychiatry, Leiden
University Medical Center, and bDepartment of Psychology,
Faculty of Behavioral and Social Sciences, Leiden University,
Leiden, cDepartment of Psychiatry, Free University, Amsterdam,
and dDepartment of Medical Psychology and Psychotherapy,
Erasmus University, Rotterdam, The Netherlands Childhood Adversities as Risk Factors for Alexithymia
and Other Aspects of Affect Dysregulation in Adulthood
Psychother Psychosom 2004;73:107-116 (DOI:10.1159/000075542)
ABSTRACT Background: Affect regulation
is assumed to be a biologically based function that
can become disrupted by inadequate parenting and by
traumatic experiences. We studied the relation between
the perceived parental parenting style, and sexual
and physical abuse, with alexithymia, dissociation,
anxiety and depression. Methods: In a cross-sectional
study psychiatric outpatients were administered a
structured interview on childhood physical and sexual
abuse and they completed a number of questionnaires
about the parenting styles of their parents, and about
alexithymia, dissociation and mood pathology. Results:
Maternal and paternal parenting styles were moderately
correlated with alexithymia and depression. The paternal
parenting style was also correlated with dissociation.
Optimal parenting of one of the parents had a buffering
effect on the degree of alexithymia, but not on the
severity of other forms of affect dysregulation. The
effect of sexual or physical abuse did not add to
that of parental parenting style in terms of predicting
affect dysregulation. However, a positively perceived
maternal parenting style was found to have a buffering
effect in terms of the degree of alexithymia, if sexual
abuse had also taken place. Conclusions: Perceived
parenting does appear to be of some significance in
the development of alexithymia. Optimal parenting
of one of the parents may protect against the development
of alexithymia when the parenting of the other parent
is perceived as non-optimal. However, it is likely
that other factors besides parental care and sexual
or physical abuse play an important role in the development
of an adequate affect regulation.
Cheryl Koopman
;Victor Carrion, Lisa D. Butler, Shiv Sudhakar, Laura Palmer, Hans Steiner
(2004) Relationships of Dissociation and Childhood Abuse and Neglect with Heart Rate in
Delinquent Adolescents Journal of Traumatic Stress
17 (1): 47-54, February 2004, doi:10.1023/B:JOTS.0000014676.83722.35
ABSTRACT This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.
Koos O, ;
Gergely G. (2001) Department of Developmental Research
at the Institute for Psychology, Hungarian Academy of
Sciences, Budapest. kooso@mtapi.hu A contingency-based
approach to the etiology of 'disorganized' attachment:
the 'flickering switch' hypothesis. Bull
Menninger Clin 2001 Summer;65(3):397-410
ABSTRACT The authors present a
new approach to the etiology of disorganized attachment
based on contingency detection theory. According to
this view, the relevant common factor in parental
maltreatment and unresolved loss that leads to disorganized
attachment has to do with the type of "deviant
contingency environment" that both of these conditions
generate. In such environments, infants experience
periods of being in control followed by periods of
sudden loss of control over the caregiver's behavior.
The authors hypothesize that this adversely affects
the developmental unfolding of the infant's innate
"contingency detection module" (Gergely
& Watson, 1999), which normally involves a maturational
shift around 3 months from an initial attention bias
for perfectly contingent stimulation to an emerging
preference for less-than-perfect social contingencies.
The periodically changing controllability of abusive
and dissociating "unresolved" attachment
figures is hypothesized to block this process and
to lead to the defensive fixation of a dysfunctional
"flickering contingency switch" mechanism
with two dominant and competing target positions (self-oriented
vs. other-oriented). This results in the dissociative
style of attention and behavioral organization characteristic
of disorganized infant attachment. The authors summarize
the preliminary results of an empirical study that
provides support for this model in 6.5-month-old infants
using a modified Still-Face situation (the Mirror
Interaction Situation). The study demonstrates differential
emotional and behavioral reactions to sudden loss
of maternal contingency and a specific interest in
exploring the perfectly contingent self-image in the
mirror in infants who at 12 months become categorized
as "disorganized" in the Strange Situation.
Salla Koponen, M.D.,
Tero Taiminen, M.D., M.Sc.D., Raija Portin, Ph.D., Leena
Himanen, M.A., Heli Isoniemi, M.D., Hanna Heinonen, M.D.,
Susanna Hinkka, Ph.Lic., M.Sc., and Olli Tenovuo, M.D.,
M.Sc.D (2002)
Axis I and II Psychiatric Disorders After Traumatic Brain
Injury: A 30-Year Follow-Up Study Am J Psychiatry
159:1315-1321, August 2002
ABSTRACT OBJECTIVE: Patients who
had suffered traumatic brain injury were evaluated
to determine the occurrence of psychiatric disorders
during a 30-year follow-up. METHOD: Sixty patients
were assessed on average 30 years after traumatic
brain injury. DSM-IV axis I disorders were diagnosed
on a clinical basis with the aid of the Schedules
for Clinical Assessment in Neuropsychiatry (version
2.1), and axis II disorders were diagnosed with the
Structured Clinical Interview for DSM-III-R Personality
Disorders. Cognitive impairment was measured with
a neuropsychological test battery and the Mini-Mental
State Examination. RESULTS: Of the 60 patients, 29
(48.3%) had had an axis I disorder that began after
traumatic brain injury, and 37 (61.7%) had had an
axis I disorder during their lifetimes. The most common
novel disorders after traumatic brain injury were
major depression (26.7%), alcohol abuse or dependence
(11.7%), panic disorder (8.3%), specific phobia (8.3%),
and psychotic disorders (6.7%). Fourteen patients
(23.3%) had at least one personality disorder. The
most prevalent individual disorders were avoidant
(15.0%), paranoid (8.3%), and schizoid (6.7%) personality
disorders. Nine patients (15.0%) had DSM-III-R organic
personality syndrome. CONCLUSIONS: The results suggest
that traumatic brain injury may cause decades-lasting
vulnerability to psychiatric illness in some individuals.
Traumatic brain injury seems to make patients particularly
susceptible to depressive episodes, delusional disorder,
and personality disturbances. The high rate of psychiatric
disorders found in this study emphasizes the importance
of psychiatric follow-up after traumatic brain injury
Kruger C, Mace CJ.
(2002) Department of
Psychiatry, University of Pretoria, Pretoria, South Africa.
ckruger@postillion.up.ac.za Psychometric
validation of the State Scale of Dissociation (SSD) Psychol Psychother 2002 Mar;75(Pt 1):33-51
ABSTRACT Although dissociative phenomena
are often transient features of mental states, existing
measures of dissociation are designed to measure enduring
traits. A new present-state self-report measure, sensitive
to changes in dissociative states, was therefore developed
and psychometrically validated. Fifty-six items were
formulated to measure state features, and sorted according
to seven subscales: derealization, depersonalization,
identity confusion, identity alteration, conversion,
amnesia and hypermnesia. The State Scale of Dissociation
(SSD) was administered with other psychiatric scales
(DES, BDI, BAI, SCI-PANSS) to 130 participants with
DSM-IV major depressive disorder schizophrenia, alcohol
withdrawal, dissociative disorders and controls. In
these sample populations, the SSD was demonstrated
as a valid and reliable measure of changes in and
the severity of dissociative states. Discriminant
validity, content, concurrent, predictive, internal
criterion-related, internal construct and convergent
validities, and internal consistency and split-half
reliability were confirmed statistically. Clinical
observations of dissociative states, and their comorbidity
with symptoms of depression and psychotic illness,
were confirmed empirically. The SSD, an acceptable,
valid and reliable scale measuring state features
of dissociation at the time of completion, was obtained.
This is a prerequisite for further investigation of
correlations between changes in dissociative states
and concurrent physiological parameters.
Kuyk, Jarl M.A., Spinhoven, Philip Ph.D., Van Emde Boas, Walter M.D., Ph.D., Van Dyck, Richard M.D., Ph.D.
(1999) Dissociation in Temporal Lobe Epilepsy and Pseudo-Epileptic Seizure Patients Journal of Nervous & Mental Disease. 187(12):713-720, December 1999.
ABSTRACT Patients with epileptic seizures (ES) and especially those with temporal lobe epilepsy (TLE) share many symptoms with patients with pseudo-epileptic seizures (PES), and the differentiation between them is often difficult. There is growing evidence that a subgroup of PES patients suffer from a dissociative disorder. It is recognized that dissociative symptoms pertain to both psychological and somatoform components of experience. Questionnaires assessing dissociation might provide positive criteria for the diagnosis of PES. In this study, the Dissociation Questionnaire (DIS-Q) and the Somatoform Dissociation Questionnaire (SDQ-20) were administered to patients with ES (TLE, non-TLE) and PES. To control for the influence of general psychoneurotic complaints, the SCL-90 was administered. Apart from this, answers on a trauma questionnaire were related to the diagnosis. Results showed that PES patients scored significantly higher on the SDQ-20, also after correction with the SCL-90, and no difference was found on the DIS-Q. Also, PES patients significantly more often reported sexual traumatic experiences. A logistic regression revealed that results on the SDQ-20 have no independent value in addition to the contribution of gender, age, age at seizure onset, and the presence of sexual abuse in the prediction of the diagnosis. In conclusion, somatoform and not psychological dissociative symptoms are characteristic for PES patients in comparison to ES patients. Other measures are needed within the framework of the differential diagnosis between PES and ES.
Kroes, G., Veerman,
J.W., & De Bruyn, E.E.J. . (2000) Realiteit en vertekening bij het beoordelen van probleemgedrag
van kinderen
[Reality and bias in the judgment of children's problem
behavior]. Jaarboek Ontwikkelingspsychologie,
Orthopedagogiek en Kinderpsychiatrie, 4 (1999/2000), 87-118.
ABSTRACT Diagnostic information seems to
be informant specific. This chapter reviews the relevant
research literature. The focus is on the distortion
hypothesis, which predicts biases in diagnostic accuracy
to be related to the personality and emotional state
of the informant. It is argued that research in this
particular field can profit from Funder's (1995) comprehensive
Realistic Accuracy Model (RAM).
Kuyk J., Spinhoven
P., van Emde Boas W., van Dyck R. (1999) Stichting Epilepsie Instellingen
Nederland, Heemstede, The Netherlands. Dissociation in temporal lobe epilepsy and pseudo-epileptic
seizure patients. J Nerv Ment Dis 1999 Dec;187(12):713-20
ABSTRACT Patients with epileptic seizures
(ES) and especially those with temporal lobe epilepsy
(TLE) share many symptoms with patients with pseudo-epileptic
seizures (PES), and the differentiation between them
is often difficult There is growing evidence that
a subgroup of PES patients suffer from a dissociative
disorder. It is recognized that dissociative symptoms
pertain to both psychological and somatoform components
of experience. Questionnaires assessing dissociation
might provide positive criteria for the diagnosis
of PES. In this study, the Dissociation Questionnaire
(DIS-Q) and the Somatoform Dissociation Questionnaire
(SDQ-20) were administered to patients with ES (TLE,
non-TLE) and PES. To control for the influence of
general psychoneurotic complaints, the SCL-90 was
administered. Apart from this, answers on a trauma
questionnaire were related to the diagnosis. Results
showed that PES patients scored significantly higher
on the SDQ-20, also after correction with the SCL-90,
and no difference was found on the DIS-Q. Also, PES
patients significantly more often reported sexual
traumatic experiences. A logistic regression revealed
that results on the SDQ-20 have no independent value
in addition to the contribution of gender, age, age
at seizure onset, and the presence of sexual abuse
in the prediction of the diagnosis. In conclusion,
somatoform and not psychological dissociative symptoms
are characteristic for PES patients in comparison
to ES patients. Other measures are needed within the
framework of the differential diagnosis between PES
and ES.